By using this technique, resection of the rectum may be extended into the anal canal by removing the internal sphincter completely or partially (‘intersphincteric resec­tion’), thus offering the opportunity for sphincter-preserving resections of tumours below 5 cm from the dentate line. In general, ultralow resection of rectal cancer with coloanal anastomosis is associated with an [...]

Continue reading " Preservation and restoration of sphincter function in patients with rectal cancer: Part 2 "

Surgery is the most important form of treatment for rectal cancer by radical local tumour control. Despite that recurrence-free survival is still the major goal of surgical therapy, it is also widely accepted that the surgeon should re­lieve distressing symptoms associated with the procedure. A major concern of patients with colorectal cancer is the possibility [...]

Continue reading " Preservation and restoration of sphincter function in patients with rectal cancer "

Despite the abundance of literature on management of acha- lasia, there appears to be a relative paucity of prospective, randomized controlled studies that directly compare differ­ent treatment modalities. Until recently, there have only been two really effective methods of treating patients with achalasia: forceful dilation and surgery. Data from uncon­trolled retrospective trials have, in general, [...]

Continue reading " Achalasia: Treatment options revisited. COMPARATIVE STUDIES "

Nitrates and calcium channel antagonists have been recom­mended for treatment of achalasia. The rationale behind the use of these medications is their potential to decrease LES tone by relaxing gastrointestinal smooth muscle. However, the limitations in the use of these drugs are several: they are short acting; they can have significant side effects such as [...]

Continue reading " Achalasia: Treatment options revisited. DRUG THERAPY "

Achalasia was one of the first gastrointestinal motility disorders to be characterized, both clinically and manometrically. Failure of relaxation of the lower esophag- eal sphincter (LES) is the cardinal feature of this disease, thought to result from a relatively selective degeneration of the inhibitory neurons in the surrounding myenteric plexus (Figure 1). This leads to [...]

Continue reading " Achalasia: Treatment options revisited "

Parathyroid carcinoma is usually associated with more severe clinical manifestations of PHPT than parathyroid adenomas. The incidence of parathyroid cancer does not favor women but is matched between the sexes, and the age of onset is approx­imately earlier than in benign disease (mid-40yr instead of the mid-50yr). The principal histological features of parathyroid car­cinoma include [...]

Continue reading " Parathyroid tumorigenesis: Genetic abnormalities in sporadic parathyroid carcinoma "

To date cyclin D1/parathyroid adenomatosis gene 1 (PRAD1) together with the MEN1 is the only gene with an established role in the development of sporadic (nonfamilial) parathyroid adenomas. The cyclin D1/parathyroid adenomatosis gene 1 oncogene The cyclin D1/PRAD1 gene was identified as a parathyroid oncogene on chromosome 11 q13, clonally activated in a sub­set of [...]

Continue reading " Parathyroid tumorigenesis: Genetic abnormalities in sporadic parathyroid adenomas "